Clinical and Translational Research
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2023; 12(2): 38-44
Published online Mar 9, 2023. doi: 10.5409/wjcp.v12.i2.38
Factors associated with subsequent surgery after septic arthritis of the knee in children
Jennifer Marie O’Donnell, Ernest Ekunseitan, Ishaan Swarup
Jennifer Marie O’Donnell, Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, United States
Ernest Ekunseitan, Medical School, University of California San Francisco, San Francisco, CA 94143, United States
Ishaan Swarup, Pediatric Orthopaedic Surgery, UCSF Benioff Children’s Hospital, Oakland, CA 94609, United States
Author contributions: O’Donnell JM, Ekunseitan E, and Swarup I all contributed to this work; O’Donnell JM and Swarup I designed the research study; O’Donnell JM and Ekunseitan E performed the research; O’Donnell JM analyzed the data; O’Donnell JM wrote the manuscript; Ekunseitan E and Swarup I edited and reviewed the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study was exempt by the local institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: The authors will make available all data which are also part of a publicly available database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ishaan Swarup, MD, Assistant Professor, Pediatric Orthopaedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, Oakland, CA 94609, United States. ishaan.swarup@ucsf.edu
Received: December 1, 2022
Peer-review started: December 1, 2022
First decision: December 13, 2022
Revised: January 13, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 9, 2023
Processing time: 95 Days and 5.8 Hours
ARTICLE HIGHLIGHTS
Research background

Septic arthritis in children is a challenging clinical problem and carries with it many long-term sequelae. Repeat surgeries are sometimes necessary to eradicate infection. Understanding the rate of repeat irrigation and debridement in this population, and the risk factors associated, can help to focus clinical interventions and future studies.

Research motivation

Septic arthritis of the knee can be a serious clinical problem, and affects children and their families greatly. Understanding further the rate and risk of requiring multiple surgeries can help surgeons in counseling of these patients and their families.

Research objectives

To determine the rate of repeat irrigation and debridement in children who undergo surgical washout of the knee. Secondarily, the aim is to highlight any significant risk factors associated with repeat surgery.

Research methods

This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize this data. Univariate and multivariate analyses were performed with all variables with P < 0.10 on univariate analysis.

Research results

Nine-hundred thirty-two patients were included in this retrospective database study. In total, 36 (3.9%) of these patients underwent subsequent surgery after surgical irrigation and debridement for septic arthritis of the knee. In univariate analysis, CCI at the time of initial treatment was significantly higher in the cohort who underwent subsequent surgery (P = 0.041). Shorter length of stay at the time of index admission trended towards significance as well and was therefore included in the subsequent multivariate analysis (P = 0.066). Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of subsequent surgery.

Research conclusions

In conclusion, this retrospective database study demonstrated that in a population of 932 children who underwent initial surgical irrigation and debridement for septic arthritis of the knee, subsequent surgery was undertaken in 3.9% (n = 39) of them. Higher index CCI and shorter LOS were significantly associated with the group requiring repeat irrigation and debridement.

Research perspectives

Future research in this area should include prospective studies of septic arthritis of the knee in children, and can follow patients long-term for sequelae of disease. This study was limited as a retrospective database study to the clinical data available.